Payer-Provider Collaboration Critical to Meeting Price Transparency Mandates

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  • Ignoring price transparency mandates will not make them go away

  • Will the No Surprises Act be the dagger in the heart of fee-for-service payments?

  • What changes to the No Surprises Act may be coming? And when?

  • Will Advanced EOB’s force payers and providers to collaborate more?

  • How might price transparency impact the workflow of health plans and providers?

  • Will price transparency regulations help patient engagement? Or create a customer service nightmare?

Our second Focus Area Roundtable on Price Transparency – facilitated by HealthSparq – took place on Wednesday, June 16th and members of the HCEG Network and industry thought leaders including Denny Brennan, Executive Director and Chief Executive Officer of HCEG partner Massachusetts Health Data Consortium (MHDC), raised and explored these and other questions.

Ferris Taylor kicked off the roundtable by asking Matt Parker, Vice-President of Products at HealthSparq, to frame the conversation by sharing a highlight of the keynote presentation “Path to Transparency – Increasing Access, Lowering Costs, and Driving Value that Matt presented along with two other healthcare leaders at the World Health Care Congress Virtual 2021 conference.

Price Transparency – Part of the Foundation for Patient Engagement

Matt Parker related that the Transparency in Coverage Mandate and No Surprises Act presents unique challenges for health plan payers and providers that can only be addressed via increased collaboration. Matt shared that price transparency is just a tool, a component to facilitate payer and provider interaction with their members and patients – not an end in itself but rather something for helping members, patients and providers better understand available provider networks, find care when they need it, engage with the system, and understand what costs are going to be – from both the member, patient, and provider perspective.

Matt suggested this price transparency foundation is the floor on which health plans and providers can build more holistic engagement with their members and patients.

RELATED: Recap of 1st Focus Area Roundtable on Price Transparencyhealthcare transparency in coverage. No surprises act. healthsparq price transparency

Building Upon the Floor Established by Price Transparency Mandates

To build upon the idea of compliance with transparency mandates as the floor, a health plan participant asked: How do we separate the basic needs of meeting the mandate from the next phase once pricing data is out there? And once basic needs are met, how can we then use that accomplishment to do things to support our members to engage with our providers more effectively? How can we help members with their provider relationship?

These few questions and others raised by participants affiliated with both health plans and provider organizations shaped the discussion and interaction throughout the roundtable.

Primary Topics Discussed by Roundtable Participantshealthcare data interoperability surescripts focus area roundtable HCEG

Our Focus Area Roundtables are informal discussions where all participants can contribute insight and raise questions. This post presents a number – but not all – of the contributions made by roundtable participants. Additional content will be shared in future posts, our social channels, and in future roundtables. To receive additional information on this and other Focus Area Roundtables, join our newsletter, follow @hcexecgroup on Twitter, connect with us on LinkedIn, and consider participating in upcoming roundtables.

RELATED: Join our Interoperability roundtable on July 20, 2021 at 10:00 AM PT / 1:00 PM ET

Who’s on First? Low Levels of Initial Compliance Due to Confusion?

One participant referenced a recent study published by JAMA that noted low compliance with the price transparency mandate by hospitals. In response, another participant noted that at his health plan, there was confusion about what is required and who is responsible for compliance with current price transparency mandates.  He noted that some staff were not aware of the upcoming January 2022 price transparency deadline for health plans, or thought it was provider-related, not health plan-related.

To be clear, while there are price transparency mandates for both providers and health plans, the JAMA study referenced the hospital-related mandate effective earlier this year on January 1st. Effective dates for price transparency-related mandates for health plans and the specific capabilities required are noted in the following table:

Transparency in Coverage Mandate – Health Plan/Payer

January 2022 Public access to pricing data through machine-readable files
January 2023 Personalized, out-of-pocket estimates via online, self-service tools
January 2023 Pricing data available for 500 services
January 2023 Pricing data available for all covered services via online tools or print delivery

No Surprises Act – Health Plan/Payer

Cost-sharing price comparison by phone or internet for specific service/item
Advance EOB w/ provider and contracted rate for in-network services. Out-of-pocket cost estimate for Out-of-Network services at least 3 days in advance
Provider directories updated & verified every 90 days w/ info updated within 2 business days of receipt. Health plan process for organizations not responsive to verification attempts.
RELATED: Diving into the Details: What You Need to Know About the Machine-Readable Files Mandate

Ideal Outcomes of Payer-Provider Compliance with Price Transparency Mandates

From a health plan perspective, compliance with price transparency mandates should help providers deliver care more effectively – as viewed by the patient. From the provider’s standpoint, a tighter integration with their health plans should enable providers to answer pricing questions from their patients.

If Mandates are Ignored, Will They Go Away – Or At Least Be Delayed?

Transparency in Coverage Mandate and No Surprises Act

MHDC’s Denny Brennan shared how some provider and payer organizations are viewing the mandates:

‘Perhaps there’s a bit of willful denial about sharing data partly driven by the fact that pricing information has long been held on the provider side in chargemasters, which are notoriously poorly maintained files with respect to what the patient’s actual exposure will be. Providers and plans are still looking at pricing data as part of their proprietary contracting process and may be essentially ignoring the mandate.’

Denny also offered that the idea of sharing pricing data hasn’t settled in across the industry because health plans are waiting for providers to take the lead and many providers are thinking: “We don’t know how to do that, we don’t know if we want to do that, and if we pretend it’s not happening, it may go away – especially because so many things have been pulled back with COVID-19.”

RELATED: Meeting Transparency Mandates: Put Your Employer Groups at Ease

Delays to No Surprises Act – Likely Clarified by August 2021

Ferris asked HealthSparq’s Matt Parker if he anticipated that the payer-side legislation might get delayed. Matt stated that while the Transparency in Coverage rules are finalized in theory, will take place over the next few years as defined, and will likely not be changed, there are not any sufficiently defined rules pertaining to transparency-related parts of the No Surprises Act – including the Advanced EOB requirements.  Matt also shared that updates to the No Surprises Act are likely to be released next month in July.

Listen here for more on potential delays to the No Surprises Act.

Other Mandates Taking Precedence over Transparency?

Participants noted that other regulations, mandates, and rules are taking precedence over – or at least complicating compliance with – the Transparency in Coverage Mandate and No Surprises Act including:

An Old Cliché Rings True: Garbage In – Garbage Out

One participant with decades of experience serving health plans noted that 80-90% of medical bills have errors of some type and this means that price transparency and data sharing mandates are starting from a system that is already error-laden. Accuracy needed to automate information interchange does not always exist and we have to clean up our act before we put it on stage.

She echoed questions posed by her clients:

  • Where am I going to pull this data from?
  • How am I going to get this out of my systems into data files?
  • Who are knowledgeable partners that can help with the generation and hosting of machine-readable files?
RELATED: Understanding the Transparency in Coverage Mandate

Health Plans as Definitive Sources of Health Information

On the topic of who’s best positioned to serve the information needs of members and patients, Denny shared that:

“What we’re telling our members is, and this is a tough message for the provider community, is that the route by which patients/members/consumers will be getting their health data is through their health plan. And the regular interchange and exchange of data between health plans and providers is great for providers who need to manage care. But providers are not envisioned in the rules as being the definitive source of patients/member/consumer health information – that’s going to be coming through their health plan.”

Incomplete and Insufficiently Specified Rules Hamper Meaningful Transparency

Healthcare data includes administrative, clinical, and financial data held by both providers and health plans and subject to HIPAA and other federal and state regulations. Denny shared his take on challenges health plans and providers are encountering due to insufficiently detailed regulations and unresolved elements of payer-provider-consumer interoperability for the purposes of value-based care.

Listen here for more on considerations regarding the current state of interoperability rules.

Advanced EOB’s – Forcing Payer-Provider Collaboration & Impacting Workflow Providers?

Providers need to be able to sufficiently integrate with health plans to get a fairly accurate estimate of the cost of specific procedures. Matt shared his take on the Advanced Explanation of Benefits (EOB) portion of the No Surprises Act and suggests it will force payers and providers to create a technology solution in their workflow.

Listen here for more on the impact of Advanced EOB’s.

RELATED: Advance EOB, Patient/Consumer Protections, and Reporting

No Surprises Act – The Dagger in the Heart of Fee-For-Service?Price Transparency Mandate Kills Fee-for-Service Payment. Value-based payment models

MHDC’s Denny Brennan shared his take on how the movement to more transparency and interoperability mandates may speed the movement to value-based payment arrangements.

“One of the things that I infer from these discussions is that the No Surprises Act is almost a forcing function. As I’ve said to members of our group, if there was ever a dagger, that could be driven into the heart of fee-for-service medicine, it’s the No Surprises Bill. Because in order to prop this thing up and to burden the physician with telling the patient at the point of care that: “Well we want to get you an MRI but if we get it down the street instead of in our own network you’ll save more money.” And physicians hate that. They don’t want to have those conversations. It’s hard enough to get physicians to talk about social determinants of health.

Listen here for more on the potential impact on fee-for-service payment models.

Impact of Increased Transparency on Customer Service

In response to participants’ discussion about transparency mandates forcing greater adoption of value-based care models, Ferris asked whether there might be a consumer backlash based on missing or inaccurate pricing information and how it might be solved. One participant predicted a customer service nightmare for health plans and providers, and another stated that it’s a problem that is going to be solved by a crowd – not by individual organizations.

Listen here for more on the potential impact of mandate compliance on customer service.

RELATED: Price Transparency Resources for Health Plans

Connect with Others Facing Similar Challenges

Special thanks to Matt Parker and HealthSparq for their role as our Focus Area Partner for Price Transparency. For more information on the meeting and exceeding price transparency mandates and to learn more about topics presented in this post, check out HealthSparq’s website and contact HealthSparq here.

If you’re a leader of a health plan, health system, or hospital/provider organization, consider joining future Focus Area Roundtables on Price Transparency, Interoperability, NextGen/Value Payment Models, and Healthcare Policy & ACA. We have other Focus Areas of the 2021 HCEG Top 10+ under development.Healthcare Executive Group Focus Area Partners HealthSparq Softheon Surescripts Zelis

Healthcare Policy Changes. Focus Area Roundtable. HCEG. HealthCare Executive Group. Regulatory. Regulations. Policy. Mandates. Interoperability. Data transparency. Non-Compliance.

Impact of Healthcare Policy Changes & New Regulations – Healthcare Leader Insight & Opinions

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With the new presidential administration, staying abreast of and responding to new and changing healthcare policy changes, legislation, and regulatory activities is more important than ever. And with uncertainties about the longevity and true value of changes forced by the pandemic, the ease in which nontraditional businesses are entering the health care space, and increasing opportunities for employing technology, learning how other health plans, health systems, and healthcare provider organizations are addressing these regulatory and policy impacts affords unique value to healthcare executives.

On Tuesday, May 26th, 2021, a dozen senior executives serving the healthcare industry gathered for our second Focus Area Roundtable on Healthcare Policy & the ACA. In this session moderated by HCEG Executive Director Ferris Taylor and supported by Kevin Deutsch, General Manager & SVP of Health Plan Cloud at Softheon – our Focus Area Partner for Healthcare Policy & ACA – attendees were presented with four questions on which to share their insight, ideas, and questions for each other.Healthcare Policy Changes. Focus Area Roundtable. HCEG. HealthCare Executive Group. Regulatory. Regulations. Policy. Mandates. Interoperability. Data transparency. Non-Compliance.

Highlights of Healthcare Policy Changes – Focus Area Roundtable #2

This post shares some highlights of participants’ responses to the questions shared by Ferris and information shared by Kevin.  Access Healthcare Leaders Focus on Healthcare Policy & ACA – a recap of the 1st Focus Area Roundtable on Healthcare Policy & ACA and read on for more information on participating in future Focus Area Roundtables.

The roundtable kicked off with Ferris asking attendees: What are your expectations for healthcare policy changes over the next 2 to 4 years?

One participant suggested that the most important regulatory/policy areas for the government would be to set clear requirements and clarify the compliance details around interoperability and data transparency.  Policies to encourage and support digital health initiatives that address the practical flow and exchange of data – from the point of view of the regular doctor and patient – were identified as most important. Generating and consuming machine-readable data that includes prices healthcare providers negotiate with payers was identified as a primary challenge – particularly given the reluctance of payers and providers to publicize that type of data. Discussion continued on transparency mandates and policies.

A Backlash for Non-Compliance with Transparency Regulations?Healthcare Price Transparency Focus Area Roundtable

One provider participant suggested the current level of ambiguity regarding the type of pricing information hospital facilities must share, along with the relatively low current penalties for not meeting the requirement, might drive some organizations to simply face the potential cost of penalties versus the cost and implementation challenges associated with compliance. Attendees noted that costs and potential negative impact associated with disclosing contracted prices could be greater than the penalties of non-compliance. In the end, leaders of provider organizations must weigh the potential backlash of non-compliance against meeting detailed requirements of the regulations.

RELATED: Join us for our 2nd roundtable on Price Transparency on June 16th, 2021 at 10:00 AM PT / 1:00 PM ET

Ferris asked participants to share their insight on what the implications for non-compliance might be for the consumer.

A chief executive officer shared that he honestly could not assess how much, if any, of a consumer impact there might be due to current levels of skepticism about the utility of price transparency shopping tools. He noted recent research suggesting that, even if granted more information, people are not very good shoppers of healthcare services. He noted recent, direct experience in reaching out to health plan members with information on the potential to save over $1000 on an imaging exam where only 30% of the consumers accepted the recommendation with the balance going with their originally prescribed venue.

Participants noted that this reluctance from healthcare consumers might change over time and that healthcare organizations need to focus on educating and supporting consumer acceptance and usage of price transparency tools.

Bipartisan Support & Permanency of Pandemic-Induced Healthcare Policy Changes

A CEO participant shared that he was not very optimistic about significant changes to popular areas of policy such as Medicare Buy-In, Public Option, and Medicaid Expansion.  He suggested that the focus would be more about bipartisan issues as opposed to those demanding substantive partisan agreement. Drug pricing was noted as one bipartisan issue that may see some change.

Another area of the discussion centered on the permanency of policies that were temporarily reversed over the last year during the course of the pandemic. Policy extensions for things that probably should have been fixed long ago, telehealth for example which took a pandemic to shine a light on, would likely be made permanent.

Permanency & Impact of Policies Regarding Open Enrollment, Subsidies, & COBRAHealthcare policy changes and regulations. ACA open enrollment subsidies, single payer, public option, Medicare/Medicaid buy-in, block grants, CMS Interoperability and Patient Access

Ferris noted how open enrollment for individual markets had been extended and that eligibility for and levels of subsidies provided to individual members using ACA marketplaces has been expanded over the last year. Ferris queried participants as to whether those policies might be made permanent and what impact might result from reverting back to previous subsidy determinations as compared to the current environment where a million new individuals have enrolled into the ACA Marketplace.

Open enrollment policies were raised by one attendee as conditional based on employment levels and likely influenced by state-level needs and policy determinations.

While one participant noted the potential for more permanent changes to eligibility for subsidies and the level of subsidies, that participant also noted that subsidies related to COBRA coverage would likely not be made permanent because COBRA is directly impacted by the dynamics regarding unemployment and the need for coverage extension.

Impact of Open Enrollment & Subsidies on Underwriting & Reconciliations

Given mid-year changes to open enrollment periods and subsidy levels, a high degree of uncertainty as to what health plan populations look like can exist – all while health plans are building packages for the next benefit year. One participant shared that extended open enrollment periods introduce a variable that plans haven’t seen before and are likely to produce underwriting challenges for health plans in 2022 and beyond.

‘You’re never really closing the books on the one year before you’re getting ready to reload for the next year.’ – Roundtable Participant

RELATED: Healthcare Policy, ACA 2.0, Enrollment Period Lessons, & The Journey to the Exchange

Potential Areas for Healthcare Policy Changes & New Regulations

A number of areas were identified as top of mind for both health systems and health plans and ripe for new regulations and development of formal policies:

  • Payment parity for telehealth services
  • Removal of barriers to site of service and venue for telehealth engagement
  • Alternative payment models
  • Quality measures
  • Health equity
  • Holistic/whole-health care delivery

Cost of Care: A Failure of the ACA & Political Platform in 2022 & 2024?

Regulations and policies regarding eligibility for subsidies and their levels were noted as a symptom that the ACA, while it did a good job addressing coverage, didn’t really address the cost of care. While the cost of premiums can be controlled through greater subsidies, doing so doesn’t solve the problem. The problem is that health care costs too much and that’s driving either premiums up or subsidies up, neither of which are good.

One participant noted that the entry of non-traditional market participants like Amazon are just the results of not addressing the cost of care through the ACA over the last decade.

As one participant asked: ‘Can we really expect the current structure of the federal government to make major policy changes that might affect the cost of care?’ Another participant added: ‘While it may not happen this year or next, it’s possible that you’ll see the political parties run specifically on a cost of care platform for 2022. And certainly for 2024.’

Technology as a Force Multiplier to Address Healthcare Policy Changes

Ferris asked panelists what they see as the role of technology in addressing policy changes and how technology will make an impact beyond the ACA – to consumers, providers, health plans, payers, and hospitals.

One participant’s response:

‘I’m seeing technology as a force multiplier in a competitive advantage – a leveraging of clinicians whether they are acting as a call center coach or a nurse navigator. That model is tough to scale and so clinicians are best focused on high clinical acuity and complex care. And where we’re seeing technology best applied is where it’s being leveraged from a preventative, chronic care, and wellness perspective. You can engage more members and have a personalized experience across a broader swath of either membership and/or lines of business as well as it being a personalized experience.

And that includes leveraging remote patient monitoring capability, wearables, Etc. And so right now for a commercial line of business, you can do, for example, digital coaching and get reimbursed for it. But when it comes to government programs, that’s not been in effect yet. So, I think, as it becomes more commonplace in the commercial market in evolution it will be more common in government programs.’

No Area of Healthcare Will Be Untouched by Technology

A health plan chief executive officer shared:

‘It’s hard to think about any area that won’t be touched by technology. I think technology is going to reinvent the shopping experience in healthcare for both obtaining health insurance as well as care delivery. If we wonder what technology should do, we have to realize that Amazon is a technology company that brought the store to the house. And Netflix is a technology solution. And Uber is a technology solution. So why would we think that isn’t going to happen in healthcare, both on the plan and the care delivery side? I think technology is already revolutionizing care delivery so that much of it can be provided in the home if people want it there, or in the cloud.’

The participant went on to share additional insight on technologies likely impact on shopping, care delivery, and drug development.

RELATED: Healthcare Price Transparency – Leaders Share Insight – Part 1

Need for Ubiquitous Access to Healthcare Services & User Acceptance of Technology’s Limitations

One attendee commented about the need for ubiquitous access to healthcare services in all locations – urban, suburban, and rural – and the growing acceptance of technology-related glitches by healthcare consumers:

‘And the other thing that I really see that I think technology is going to go ahead and really flourish is that when you think about what happened with the pandemic and with people going ahead and deciding to work remotely; for some of them to flee the city’s and go to places where they may not be directly surrounded with a lot of health care options. They’re going to want to have the convenience of obtaining health care through technology because they’re not going to be so close to healthcare service options anymore.

I also see the attitude right now that when people used to say: ‘OK, there was something wrong with the technology and I’m not going to use it.’ Now they say: ‘Okay, well that’s just part of the package, something’s going to happen. There’s going to be a glitch but that’s just part of it’’ And they accept it. So, I think that with more of that type of acceptance, more and more people are just going to, as far as physicians and everyone’s health systems, are just going to accept it.’

Disintermediation – Patient, Physician/Provider, or Payer – All Others BewareHCEG Healthcare Policy Patient Payer Physician Provider Triangle

A chief executive officer of a provider organization offered that there’s going to be a lot of disintermediation between the real customer who’s the patient, the provider who’s the physician, and the health plan who’s the payer. He believes this because the information that’s available via personal digital tools and the movement to at-home care are going to really empower patients – i.e., consumers – to do a lot better with their health. He stressed the importance of focusing digital solutions on what providers and patients need – not on supporting the economics of the healthcare model.

He described a triangle of who’s paying, who’s getting the care, and who’s providing it and opined that companies not in that triangle are going to be disintermediated over the coming years.

Join Our Focus Area Roundtables

If you’re an executive/leader of a health plan, health system, or healthcare provider organization, consider joining one or more of our Focus Area Roundtables. In addition to Healthcare Policy & ACA, we currently have roundtables on Price Transparency, Interoperability, Next Gen/Value Payment Models, M&A/Joint Ventures and are establishing others based on 2021 HCEG Top 10+ focus areas.Join HCEG and/or participate in our Focus Area Roundtables

Complete this short form to share the focus areas you are interested in and how you’d like to participate with the HealthCare Executive Group. We’ll get back to you with information on participation.

For more insight and information on the challenges, issues, and opportunities facing healthcare leaders, subscribe to our newsletter and connect with us on Twitter and LinkedIn.Healthcare Executive Group Focus Area Partners HealthSparq Softheon Surescripts Zelis

Insight on Using Data & Analytics to Address Healthcare Consumer Needs. HCEG Top 10. Member Data. Insights. Pre-Authorization Process. HCEG. WHCC.

Insight on Using Data & Analytics to Address Healthcare Consumer Needs

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Health plans have more data and analytics than they typically know what to do with.  The challenge is to use new types of data and advanced analytics like artificial intelligence and machine learning to derive insights and actionable information that all stakeholders – healthcare consumers, providers, and payers – can use to facilitate access, improve outcomes, and reduce costs. It’s no wonder that Data & Analytics consistently ranks high on the annual HCEG Top 10 list of challenges, issues, and opportunities facing healthcare leaders.

On Wednesday, April 28, 2021, HCEG Executive Director Ferris Taylor moderated “Use Data to Uncover Insights and Create Actionable Strategies that Address Member Needs,” a webinar hosted by our partner World Health Care Congress with the following healthcare leader panelists:

This post shares highlights of some of the insight, expertise, and experiences shared by the above executives during the webinar. Access a recording of the webinar here and hear from the panelists themselves at the [specified recording time] listed with each of the session highlights presented below.

Strategic Focus on Using Data & Analytics to Find New, Actionable Insights

Ferris Taylor kicked off the discussion by asking panelists to introduce themselves and to share, from a strategic point of view, a quick overview of how they are using data and analytics to find new and actionable insights.

Leveraging Social Determinants of Health

Sherri Zink shared her organization’s focus on improving member engagement by leveraging different data across multiple silos – including social determinants of health data from 3rd parties – to help providers engage with plan members on a more holistic basis.  Listen at [00:04:41]

Anticipating Member Needs & Personalizing Interactions via Workflow

Shawn Wang offered how his health plan is better anticipating members’ needs and personalizing interactions via existing workflows.  Listen at [00:07:30] for more on:

  • Importance of embedding data and AI insight into workflows
  • Personalizing member interactions with personalized care plans, personalized news, and personal topics that address member needs.
  • Reducing overall burden by removing complexity from staff member jobs

Earning Trust of Members By Giving Them Something in Return

Mohammad Jouni shared how technology partners can support health plan member’s medical needs and administrative needs as members are interacting with health plans during other customer service events. Listen at [00:09:37]

RELATED: Leadership, Trust & Skills in Overcoming Obstacles to Radical Innovation in HealthcareInsight on Using Data & Analytics to Address Healthcare Consumer Needs. HCEG Top 10. Member Data. Insights. Trust. Process. HCEG. WHCC.

Uncovering Insights & Actionable Information: Opportunities, Challenges, & Points of Pain

Panelists shared information on the pain points and challenges that their health plan or health plan customers have addressed or still trying to address in making data and analytical tools actionable to support the relationships between the health plan, the consumer, and the provider.

Supplying Business Partners with Meaningful, Actionable Data

Sherri conveyed the importance of taking advantage of teachable moments during member interactions with customer service, capturing and leveraging unstructured data presented during interactions, and making data and analytics available in downstream systems and to provider partners. Listen to Sherri at [00:12:22]

Importance of Thinking About Data from Standpoint of Member, Not the Organization

Many health plans organize their company by functions and not around the member. Shawn shared his thoughts on the importance of a cohesive, end-to-end process, using data from the member’s viewpoint and not from an organizational standpoint, and embedding data and analytics into organizational workflows.  Shawn shares at [00:17:30]

Importance of Member Trust & Trust in the Process

Mohammad talked about the need to earn member trust and how vendors who establish trust with plan members can do a lot for the member that health plans or providers might otherwise not easily accomplish.  Listen at [00:33:33]

Applications Having Greatest Impact from Data & Analytics

Sherry shared insight on what applications are having the greatest impact from improved data and analytics, the need for member trust, and how Net Promoter Scores are impacted. Listen at [00:36:13]

Major Impact on Reducing Duration of Pre-Authorization Process

Shawn shared how high-volume, complex back-office processes like pre-authorization and other utilization management functions benefit greatly from improved data and analytical capabilities. Listen at [00:40:48]

RELATED: Healthcare System Interoperability – The Key To The Care We All Strive For

Vendor Interactions Impact on Health Plan Member Satisfaction

Mohammad stated that closing gaps in care is one of the areas seeing the greatest impact from data and analytics. He noted how new insights on member needs and member interactions with 3rd party vendors and their offerings are positively impacting plan member satisfaction and trust. Listen at [00:43:55]

Integrating New Data into Analytics and Tools Provided to Providers and Consumers

Ferris stated that there are lots of different tools out there and that it seems like data and tools are multiplying every six months. Ferris asked: As health plans, how are you integrating new data into the analytics and the tools that you’re providing to your consumers?

LISTEN to Sherri’s thoughts on the following topics at [00:46:55]

  • Insight on downstream operational systems and legacy applications
  • Making sure data produced in upstream systems is available in downstream operational systems
  • Mapping clinical data, financial data, administrative data – structured & unstructured – on-premises & cloud-based
  • Integrating 3rd party data – particularly social determinants of health

LISTEN to Shawn’s thoughts on the following topics at [00:49:43]

  • Organizing and consolidating data – Key to scaling integration capabilities
  • Capturing insight from audio interactions & acting on that insight near real-time
  • Updating analytic models frequently and timely deployment to downstream systems

RELATED: Healthcare Price Transparency – Leaders Share Insight – Part 1

Attendee Questions on Using Data & Analytics to Create Actionable InsightInsight on Using Data & Analytics to Address Healthcare Consumer Needs. HCEG Top 10. Member Data. Insights. Trust. Process. HCEG. WHCC.

Panelists had an opportunity to respond to questions from webinar attendees. Listen in at [00:53:44] to hear panelist responses on questions pertaining to the following:

  • Co-developing a data & analytics strategy with business partners
  • Defining and ranking use cases across all business units
  • Accommodating member/patient communication preferences
  • Example of addressing high-utilizer of ER services
  • Avoid taking a cookie-cutter approach

Panelists Leaders Share One Piece of Advice on Leveraging Data & Analytics

Ferris concluded the discussion by asking panelists to share one piece of advice on the broad topic of data and analytics. Listen at [01:01:58] for panelists responses on the following topics:

  • Ensure alignment with overall strategy & think through the end-to-end process
  • Start with the outcome you want to achieve
  • Demonstrate value early on

Opportunities for Insight and Interaction with Healthcare Leaders

2021 HCEG Top 10+ Focus Areas Interoperability Healthcare Policy

For more insight and information on the challenges, issues, and opportunities facing healthcare leaders, subscribe to our newsletter and check out these on-demand webinars from our partner World Healthcare Congress.

You may also consider joining other healthcare executives and thought leaders for one or more of HCEG’s Focus Area Roundtables. We currently have roundtables on the 2021 HCEG Top 10+ focus areas highlighted in the graphic below and are adding more.

Complete this short form to share which focus areas you are interested in and how you’d like to participate with the HealthCare Executive Group.

 

Healthcare Policy ACA Focus Area Roundtable. Medicare/Medicaid beneficiaries. Health Insurance Marketplace. HealthCare Executive Group HCEG. Softheon. American Rescue Plan (ARP). Expanded APTC Eligibility and Subsidy Amounts May Drive Individual Market Growth. real-time prior authorization requirements.

Healthcare Leaders Focus on Healthcare Policy & ACA

By | HCEG Content, Research | 4 Comments

Early indicators of healthcare policies’ prioritization, implementation, and/or likelihood of success can provide a head start to healthcare organizations – particularly those serving Medicare/Medicaid beneficiaries and those operating in the Health Insurance Marketplace or looking to join the Marketplace in 2022. It is in that spirit that the HealthCare Executive Group (HCEG) has created Focus Area Roundtables to promote dialogue among HCEG members on important 2021 HCEG Top 10+ priorities. This post shares highlights of the initial online discussion about Healthcare Policy & ACA and presents additional information regarding future Focus Area Roundtable discussions.

See below for Additional Focus Area Roundtables Currently Being Assembled

Healthcare Leaders Discuss Healthcare Policy & ACA

On March 11th, executives from mid-sized health plans (MSH), an integrated delivery system (IDS), a national specialty care provider (NSP), and a not-for-profit consortium focused on advancing healthcare data and technology transformation (EDC) participated in the roundtable. In a roundtable fashion, these leaders shared their thoughts, ideas, and concerns on Healthcare Policy & ACA and forecasts for how the Biden administration may reshape the American healthcare ecosystem for the years to come.

The session was moderated by HCEG Executive Director Ferris Taylor and supported by Kevin Deutsch, General Manager and SVP of Health Plan Cloud at Softheon, the 2021 Focus Area Partner for Healthcare Policy & ACA.

What are your healthcare policy & ACA-related priorities, thoughts, and concerns?

Dealing with volume and uncertainty of healthcare policy and regulations amid rapidly changing and often unstructured government programs: ACA enrollment/subsidies, single payer, public option, Medicare/Medicaid buy-in, block grants, CMS Interoperability and Patient Access, etc.It was noted that no one has a crystal ball and none of the participants were “inside” of the administration, so discussions of this type help to develop the ability to respond to the many uncertainties.  The needed speed of learning and agility to respond to changes in healthcare policy is the “new normal.”  Specific perspectives were exchanged among the roundtable participants.

MSH: Expressed concern on how to keep premium costs down for members who are largely low-income.

NSP: With $2 billion at risk in value-based programs and whose patients are mostly Medicare beneficiaries with multiple comorbidities, healthcare policy needs to:

  • Facilitate cost-effective access to coverage for Medicare and other beneficiaries.
  • Establish reasonable value-based programs and not just push out a bunch of voluntary risk-sharing programs long on objectives but short on details.
  • Support coverage and payment for virtual care, particularly remote monitoring.

EDC: Shared that consortium members have noted that recently passed rules on Interoperability and Information Blocking are top of mind. These two areas of regulation and the advent of technology standards like FHIR and code sets such as LOINC, SNOMED, and others are helping to establish a common language and ‘gauge’ to help providers to speak the same language – particularly with payers.

What components of the recently passed American Rescue Plan (ARP) are most promising to you?

MSH: As a health plan, we struggle to address premium affordability and overall cost to the member and aim to keep increases to premiums at inflation or lower. Additional costs beyond the member premium often prevent members from accessing needed care. While the pandemic did not materially impact our overall member count, it did impact the composition of members as the number of commercial members decreased while Medicaid members increased.

NSP: Mentioned the need for providers and supply-side organizations to better understand the true cost of the services and products and services they provide. And another participant noted experience with a wide variety of costs and outcomes for services provided to seemingly similar patients.

FACT SHEET: American Rescue Plan and the Marketplace

What are ARP’s Immediate, Mid-Term, & Long-Term Benefits?

Healthcare Policy ACA Focus Area Roundtable. Medicare/Medicaid beneficiaries. Health Insurance Marketplace. HealthCare Executive Group HCEG. Softheon. American Rescue Plan (ARP). Expanded APTC Eligibility and Subsidy Amounts May Drive Individual Market Growth. real-time prior authorization requirements.All participants agreed there is a large and immediate benefit associated with ARP funding for vaccine-related availability, administration, and tracking.

NSP: Increased funding of COBRA premiums at 100% through September 2021 and increases to Medicaid funding seem to be a positive, as more unemployed people will be less likely to forgo or delay needed care.

Longer-term benefits from the funding and attention drawn to mental health services by the ARP were also noted. One participant called out how historically low funding and the stigma associated with mental and behavioral health services has led to a large, undiagnosed population. The need to invest more in mental health now is needed to save more serious issues later.

EDC: Consortium members have noted the importance of funding and policy related to community health centers and the need for policy and standards related to the collection and use of Social Determinants of Health (SDoH) – particularly for Dual-Eligibles.

Softheon’s Kevin Deutsch noted that changes to ACA subsidy thresholds and payment amounts brought about by the ARP will further complicate reconciliation and payment challenges. And that additional changes to subsidies and cost-sharing reductions by the Biden Administration will likely happen, further complicating these already non-trivial plan administration and payment reconciliation challenges.

RELATED: Expanded APTC Eligibility and Subsidy Amounts May Drive Individual Market Growth

Topics for Next Healthcare Policy & ACA Focus Area Roundtable

Healthcare Policy ACA Focus Area Roundtable. Medicare/Medicaid beneficiaries. Health Insurance Marketplace. HealthCare Executive Group HCEG. Softheon. American Rescue Plan (ARP). Expanded APTC Eligibility and Subsidy Amounts May Drive Individual Market Growth. real-time prior authorization requirements.As the allocated time for the roundtable flew by, Ferris moved to close the inaugural Focus Area Roundtable by asking participants what was top-of-mind in regard to Healthcare Policy & ACA and what participants thought would be the most important topics for the next roundtable. Topics raised by participants as having potential value to other HCEG members, that might be addressed in future roundtables, and would benefit from Softheon’s experience and views across their customers include:

  • Addressing policy/regulations in regard to controlling costs – particularly for high-need, high-cost members/patients.
  • Challenges, issues, and opportunities related to direct provider contracting and value-based payment arrangements.
  • Understanding and addressing costs related to internal operations and process modifications.
  • Sharing lessons learned as to what other healthcare stakeholders are doing, and not doing, in response to rapidly changing Healthcare Policy & ACA.
  • Preparing for the many regulatory deadlines (and the frequent adjustments to timelines) such as the 1/1/2022 real-time prior authorization requirements.

Additional Focus Area Roundtables Currently Being Assembled

HCEG is currently assembling roundtable discussions on Costs & Transparency and Interoperability – two other HCEG Top 10+ focus areas closely related to and impacted by Healthcare Policy & ACA.  Additional focus areas will be added in the coming months.

If you’re an executive of a health plan, health system, or healthcare provider organization who’d like to join one of these informal, small group discussions, please reach out to us here or share your contact information via this tool. And consider joining our newsletter to receive information of potential value to healthcare executives including recaps of future Focus Area Roundtables.oin HCEG and/or participate in our Focus Area Roundtables

RELATED: Healthcare Policy, ACA 2.0, Enrollment Period Lessons, & The Journey to the Exchange

Interim 2021 HCEG Top 10 List Healthcare Leader Priorities

Identifying COVID-19 Impact on Healthcare Leader Priorities

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The healthcare industry has faced tremendous change and uncertainty for decades. Each year over the last decade, the challenges, issues, and opportunities facing HCEG members have been used to create the HCEG Top 10 list – a list of challenges, issues, and opportunities. Although most healthcare executives were likely comfortable about their priorities at the start of 2020, those healthcare leader priorities were certainly and quickly turned upside down by the emerging coronavirus pandemic. The best-laid plans demanded quick review, understanding, and revision as 2020 progressed.

COVID-19 Impact to Healthcare Leader Priorities

Accordingly, HCEG and our sponsor Change Healthcare performed a ‘flash survey’ of 228 healthcare leaders through June and July of last year to assess how COVID-19 impacted the priorities identified in the 10th Annual Industry Pulse research report – a research survey based on the 2020 HCEG Top 10 list.

The results of this COVID-19 flash survey update to the 2020 Industry Pulse were released in September of 2020. Since COVID-19 prevented the HealthCare Executive Group from hosting its 2020 Annual Forum that same month of September, a formal 2021 HCEG Top 10 list was not created but rather an Interim 2021 HCEG Top 10+ list was assembled using findings from the flash survey and discussion among HCEG’s network of healthcare executives and industry leaders.

Updating Healthcare Leader Priorities as 2021 Unfolds

As 2020 ended and 2021 began, HCEG has been collecting additional information and insight into how the coronavirus pandemic and the 2020 presidential election have impacted the priorities of new and existing HCEG members and our network of partners and associates. We are also reviewing a list of 2021 healthcare predictions and trends shared by industry leaders.

Over the last few weeks, HCEG contacted the 120+ new members who joined HCEG since early December to collect feedback on their current priorities.

HCEG Healthcare Executive Group Annual Forum Healthcare leader priorities

New HCEG Members Share Their Top Priorities

While we are still collecting additional feedback from our members and performing a comparative analysis of information collected from our members to 2021 predictions and trends shared by industry leaders, it’s clear that the pandemic has resulted in new and changed priorities for health plans, health systems, and healthcare providers. Some initial findings based on the feedback provided by new HCEG members include:

  • Consumer Experience” (#1) and “Costs & Transparency” (#2) were the most frequently noted priorities of new members.
  • Data & Analytics” (#5) was the 3rd most referenced top priority. We’re reaching out to our members to gather more specifics about this foundational priority – among other priorities that were shared.
  • Next Generation Payment Models” (#9) was the 4th most frequently noted priority.
  • COVID-19 & Pandemic Preparedness” (#11) was frequently referenced with some new members adding “Patient & Healthcare Worker Safety” as a priority.
  • Holistic Individual Health” (#7) was referenced by only two new members – both healthcare providers.
  • Reimbursement Issues,” “Addressing Underfunding of Primary Care” and “Administrative Expense” – perhaps all considered a subset of “Next Generation Payment Models” – were listed as ‘new priorities’ – mostly by members associated with health systems and healthcare providers.

RELATED: Physician Perspectives on COVID-19 Impact on the Fall Season

How has COVID-19 Impacted YOUR Priorities as a Healthcare Leader?

To help us further refine our Interim 2021 HCEG Top 10+ list, please consider sharing your priorities for 2021 via this simple, one-page survey. We’ll use your responses to create a more complete 2021 HCEG Top 10+ list and to help guide and create additional content as 2021 continues. You may also email us at [email protected].

Connect with the HealthCare Executive Group

Consider joining our newsletter to receive additional information, ideas, and insight for healthcare executives and change-makers.

Please reach out to us at [email protected] if you have any questions or comments. If you are an executive of a health plan, health system, or healthcare provider organization, reach out to us at [email protected] for information on a special membership offer available through the end of January.

Physician Perspectives on COVID-19 Impact on the Fall Season. HCEG HealthCare Executive Group. Lessons Learned. Experiences from Southern Hemisphere – Seasonal Viruses at All-Time Lows. Value of Encouraging Use of Masks. ‘Long Haulers’ – The Unknown, Long-Term Impact of COVID-19. Financial Impact on Providers, Employer Groups, & Payers. New Reimbursement Models

Physician Perspectives on COVID-19 Impact on the Fall Season (Part 3)

By | HCEG Content, Resources | 2 Comments

This is the final post of a 3-part series sharing physician perspectives on COVID-19 impact on the fall season. The information, insight, and ideas presented in this series originated from an informal discussion Ferris Taylor of the HealthCare Executive Group had with three physician executives:

HCEG board member Dr. David Diloreto, MD, a board-certified ophthalmologist, ophthalmic plastic surgeon, a principal at Vizient/Sg2 and prior senior vice-president at GE Healthcare Camden was joined by:

Dr. Johanna Vidal-Phelan, MD, Senior Medical Director in Pediatrics at the University of Pittsburgh Medical Center Health Plan and a practicing pediatrician at Hamilton Health Center, an FQHC in Harrisburg, PA and

Dr. Jason Woo, MD a practicing board-certified obstetrician/gynecologist, a veteran with 31 years in the Commissioned Corps of the U.S. Public Health Service and a consultant at the Arbinger Institute.

COVID-19 Impact to Healthcare: Topics Discussed in This Series

The trio of physician executives discussed the following topics in the first and second posts of the series:

Part 1 Topics

Part 2 Topics

– Impact Factors Affecting Utilization of Services
– Balancing Treatment to Avoid Ongoing Destruction of Demand for Non-COVID Services
– Returning to School & Addressing Disadvantaged Populations
– A Pediatric Physician on Sending Kids – Including Her Own – Back to School
– Impacts on Minorities & Underserved Populations
– Uncertainty in Testing and Understanding Prevalence
– How Long Will We Be Dealing with COVID-19?
– COVID-10 Vaccines & Importance of Fall Flu Shots
– Avoiding Other Illnesses or a Different Pandemic – Maintain Immunizations
– Vaccinations for Underserved Populations – Messaging is Key
– The Change to Telehealth: New Opportunities for Providers to Connect with Patients
– Rethinking the Healthcare Supply-Chain – PPE as a Matter of Trust

Listen to the entire recording here

Be sure to subscribe to our newsletter for more information of potential value to healthcare leaders and change-makers.

Live, Interactive Chat and Q&A – October 13th, 2020

On Tuesday, October 13, 2020, at 11:00 am PT/2:00 pm ET, Doctors DiLoreto, Vidal-Phelan, and Woo will present additional details and current insight on what can be expected for the coming fall season under COVID-19.

Join us for a live, interactive discussion and Q&A. Questions and requests for additional information shared by registrants prior to and/or during the live chat will be fielded by the panelists. Reserve your seat and submit your questions and comments today!

Lessons Learned and Lessons to Be Learned

Lessons learned during the coronavirus pandemic can help to drive innovation that transforms preparedness, care delivery, quality, safety, efficiency, and patient experience over the coming months and years. The discussion continued with the physicians sharing some lessons learned and lessons to be learned.

Experiences from Southern Hemisphere – Seasonal Viruses at All-Time Lows

Dr. David:

COVID-19 Experiences from Southern Hemisphere – Seasonal Viruses at All-Time Lows“We’re also working with folks in the southern hemisphere right now. It’s very interesting they’re in the depths of winter in the southern hemisphere. The pandemic is certainly spreading and hitting places very hard; whether it’s Melbourne Australia, Santiago Chile, Johannesburg South Africa.

What’s interesting is that the incidence of other seasonal viruses is at an all-time low – historic lows. And it’s across a long spectrum so influenza, RSV, pneumococcus remains extraordinarily low suggesting that, obviously, measures such as social distancing, mask-wearing, hand washing are going to be more important than ever. And obviously vaccinating against flu and pneumococcus for older patients is going to be important.

Hopefully in North America, as we enter into winter, we’ll get similar effects that will suppress – like we did in the spring – some of the seasonal virus activity.”

Value of Encouraging Use of Masks

Dr. Johanna:

“And I think one important point about this is mask-wearing. And so, for example, places like Australia you just mentioned. In Chile, people are being compliant with using masks. So this is a message that we really need to also share with our community and the population that wearing your mask is important not only for COVID-19 but it does prevent the exposure to other viruses and illnesses.

And that I tell my pediatric patients wearing your masses showing your love is caring and so they do it, they do it very well.”

RELATED: Surviving Coronavirus Pandemic & Thriving on the Other Side: Rapid Innovation & Telehealth

‘Long Haulers’ – The Unknown, Long-Term Impact of COVID-19

Dr. David Diloreto:

“I’d like to get your insights into are some of the issues we’re seeing with long haulers – folks who actually are continuing to demonstrate symptoms, troubling symptoms, for many weeks or months and potentially for some of them it could be long term.‘Long Haulers’ – The Unknown, Long-Term Impact of COVID-19

We’re seeing widespread neurologic complications, cardiovascular complications – obviously there are aspects of this disease we don’t quite fully understand.”

Dr. David prompted fellow panelists to share a little bit about their concerns in younger individuals who may have had minimal symptomatology but have persistent symptoms going forward that don’t seem to be resolving.

Dr. Jason responded:

“One of the challenges is that when folks say “oh, this is a hoax or this is not real,” I think part of it is just recognizing what they’re seeing right and then what’s relevant to them. The challenge is when we have all this uncertainty when we have so many different messages, and there are all these aspects about the COVID-19 virus and its pathology in the body.

We are only beginning to get a sense that folks aren’t dying from pneumonia, they’re dying from micro infarctions throughout their lungs where it’s overwhelming the immune response. That’s killing them not the typical virus reproduction. And then the neurologic symptoms and the muscle symptoms where the virus is infecting whole body systems.

COVID-19 and Its Uncertain Pathology

We just have no knowledge of that. So, when folks see things it’s recognizing there’s still a lot of uncertainty about this. What’s right for you is what is going to be right for you. But do you want to do that in a vacuum or do you want to do that with better information? So how do we help better inform you about what those risks are because we know that the data is constantly evolving?

And how do we help you be alive for that so that we’re working together to figure it out because one person going back to work by themselves is not going to fix the economy? It’s how do we do this together and how do we address all the different concerns that people are going to be having – be it their economic ones or if they’re elder parents there are long-term consequences for the individual. How do we be alive to the things that are the highest priority for them in terms of what’s the information that they need to make a better decision?”

RELATED: COVID-19 Resources for Health Plans, Health Systems, & Medical Service Providers

Financial Impact on Providers, Employer Groups, & Payers

The coronavirus pandemic has had a significant negative impact to the financial status of hospitals, physicians in private practice, and physicians employed by health systems. With patient volumes cut 60% or worse and with so many healthcare providers paid based on volume, many physicians have taken unprecedented hits to their revenue, and many organizations have furloughed or laid-off employees.

Dr. David shared how the coronavirus pandemic has likely forced all stakeholders – providers, employer groups, and payers including federal and state healthcare programs like Medicaid – into pursuing new value-based reimbursement models.

Employers Forced into New Reimbursement Models

Financial Impact on Providers, Employer Groups, & Payers Employers Forced into New Reimbursement Models“And employers who are really not that interested in thinking about value-based care – they just wanted to make sure their employees were happy with health insurance – now are looking at all kinds of – and these are small and medium-sized employers – anything they can do to eliminate costs now.

They’re much more interested in episode of care bundles and basically looking at structural reimbursement models that deliver their risk going forward. So our projections are that we (as individuals) and obviously state governments have been shielded to some degree from the economic impact by federal subsidies.

But if the economy is shut down in certain states and the tax base erodes, they’re going to have to look at their Medicaid programs in about 18 months totally differently. So there’s going to be much more cost reduction in that space.”

RELATED: Modifying the Focus of Medicaid Value-Based Payment in the Context of COVID-19

Delayed Demand for Non-COVID Services

“So the folks that are also interesting to me are payers. If you look at what’s happened in 2020, many of them obviously – with the demand destruction – now are actually looking at significant surpluses on their financials for 2020. And they’re trying to really look at certain reserving capabilities including a reserve I never knew that existed called the premium discount reserve.

But it’s a way, in this instance, of being able to move these positive income statement effects off your books and onto your balance sheet and release it in future periods. But anyway, that’s probably not for this group.”

COVID-19 Forcing Physicians to Reevaluate Reimbursement

Dr. Jason Woo asked Dr. David Diloreto how the shift in the reimbursement payment system is going to affect our ability to be able to be more comprehensive in our coverage of the population?

Dr. David Diloreto responded:

“This is one of the most interesting aspects that for almost all of my clinical career, which is 30 years now, physicians generally viewed the least risky way to get paid was on a service basis. What’s really interesting is right now in large physician groups and in single-specialty groups and health system employee groups many specialists are thinking differently. They’ve been in situations now that seen demand from elective procedures (drop significantly) and they’re worried about the future.

If you can imagine being a bariatric surgeon with a large mortgage and trying to save money for college education, the world change doesn’t look like the world is going to come back that way. So they’re having grown-up discussions about changing the reimbursement models more to deliver that risk by going to employment; to going to safer ways of getting paid including fixed fees.”

Supporting & Caring for Front-Line Providers

In addition to financial impacts which were discussed later in the session, the physician panelists shared how the coronavirus pandemic has placed a huge physical and emotional burden on many frontline providers. Ferris prompted the physician panelists to share their thoughts on this quadrant of the Quadruple Aim:

What would be effective measures to decrease the burnout rate of physicians and everyone else fighting the coronavirus pandemic?

Dr. Jason:HCEG COVID-19 Supporting Caring for Front-Line Providers

“I think that in a lot of ways it’s going to be very healthy for health care providers to be able to connect to their patient’s. I think on the other side, those frontline providers that are still stuck with trying to take care of the folks that are coming through the ER or into the ICU is where there’s still not a lot of good information. And the struggle that they’re going to go through of trying to do the best that they can with all the uncertainty in the limitations that we have. I think for those folks we have to be really mindful that there’s a great burden that our traditional thought about what the role of the provider is. We have to help see beyond right and get into that.

What’s the best that you can do? What is not the best outcome that you’re going to be able to get, wish for every patient, but what’s the best that you can do within your circumstances. And being more for more mindful of the limitations that your role is going to be, that it is going to have. I think it’s hard because be it the lack of the supply chain, the lack of PPE, the challenges of what tests are available, or not available. Until that gets standardized, until there’s been able to get some trust in the data that they have and the testing methods that they, and the treatments available it’s just going to be hard to be a frontline provider.”

Dr. David added

“I think what we do need to get is the impact on providers, front line providers, who have been through the ringer. If you just think about what they’ve had to do throughout the spring into the summer – even in outpatient practices. Now all the PPE requirements on and off; all the changes in your practice; this is really taking a toll on providers right now.”

Get Your COVID-19 Questions Answered on October 13th

The discussion ended with a general agreement that the discussion could go on for hours. Accordingly, the three physicians agreed to make themselves available for a live, interactive follow-on chat with a Q & A opportunity on October 13, 2020 at 11:00 am PT / 2:00 pm ET.

Reserve your seat and submit your questions and comments today!

Be sure to take advantage of this unique opportunity to learn more about what’s presented in this post – and please share it with your associates. And if you are not a subscriber to our newsletter, consider joining 5000+ other healthcare leaders, change-makers, and industry participants and subscribe today!

Physician Perspectives on COVID-19 Impact to Fall Season (Part 2)

By | HCEG Content, Resources | 2 Comments

Late last month, the HealthCare Executive Group hosted an informal discussion with three physician executives on their observations, experiences, and insight about how COVID-19 has impacted healthcare and healthcare stakeholders. The theme of the discussion was: “What’s changed, what’s remained the same, and what can we expect in the coming fall season?”

HCEG board member Dr. David Diloreto, MD, a board-certified ophthalmologist, ophthalmic plastic surgeon, a principal at Vizient/Sg2 and prior senior vice-president at GE Healthcare Camden was joined by:

Dr. Johanna Vidal-Phelan, MD, Senior Medical Director in Pediatrics at the University of Pittsburgh Medical Center Health Plan and a practicing pediatrician at Hamilton Health Center, an FQHC in Harrisburg, PA and Dr. Jason Woo, MD a practicing board-certified obstetrician/gynecologist, a veteran with 31 years in the Commissioned Corps of the U.S. Public Health Service and a consultant at the Arbinger Institute.

HCEG’s Executive Director Ferris Taylor helped to facilitate the discussion and provided an HCEG perspective.

This is the second post of a three-part series sharing highlights of that conversation. See the first part here and consider subscribing to our newsletter to receive the final post and other information of value to healthcare leaders and change-makers.

Topics Discussed in Part 1

The trio of physician executives discussed the following topics in the first post of this series:

  • Impact Factors Affecting Utilization of Services
  • Balancing Treatment to Avoid Ongoing Destruction of Demand for Non-COVID Services
  • Returning to School & Addressing Disadvantaged Populations
  • A Pediatric Physician on Sending Kids – Including Her Own – Back to School
  • Impacts on Minorities & Underserved Populations
  • Uncertainty in Testing and Understanding Prevalence
  • How Long Will We Be Dealing with COVID-19?

Listen to the entire recording here

Live, Interactive Follow-On Chat and Q&A – October 13th

For more detailed information on the topics presented in this series of posts and for a chance to interact with and ask questions of these physician leaders, join us on October 13, 2020 at 11:00am PT/2:00 pm ET for a live, interactive chat. The physician panelists will provide additional insight on what’s changed, what’s remained, and what can be expected for the coming fall and winter season under COVID-19.

Questions and requests for additional information shared by registrants prior to and/or during the live chat will be fielded by the panelists. Reserve your seat and submit your questions and comments today!Be sure to take advantage of this unique opportunity to learn more about what’s presented in this post – and please share it with your associates.

COVID-19 Vaccines & Fall Flu Shots

A significant part of the discussion continued on the development of a COVID vaccine and the importance of getting a seasonal flu shot to avoid undue burden to services and potential mis-diagnoses of the seasonal flu as COVID-19. Dr. Johanna shared:

Importance of Flu Shots – Minimize Avoidable Impacts

“We saw a decline of seasonal viruses during the spring and early beginning of the summer. I think right now you have to think about the monumental impact of children returning to school even if it’s for two days. Our children (Dr. Johanna’s children) have been with us since March 13th at 4 p.m. when the school released them and said ‘They’re not coming back. We don’t know when.’

 And so our children haven’t really been exposed to a lot of other people, so we do know that children are going to be exposed not only to COVID-19 but all the other normal viruses that we see; or bacteria like strep throat. I think one of the important messages that I’ve been sharing with my family since day one is the importance of the flu vaccine. And there is a lot of misinformation and misunderstanding about the flu vaccine. People still believe that you get sick from the flu vaccine. That you are going to develop the flu from the flu vaccine. A lot of families, almost not even 50 % of the population in the United States, do not get the flu vaccine every year. “

Is Herd Immunity a Potential Solution?

Dr. Johanna continued:Avoiding Other Illnesses or a Different Pandemic - Maintain Immunizations Vaccinations for Underserved Populations – Messaging is Key

“And so if we want to have a good herd immunity, it is important and I explained to the parents, that providing the flu vaccine to your child and your family is a way to combat a coronavirus. And they look at me like ‘Why? It’s a different virus.’

 And I said: ‘because when your child gets sick with the flu, because you didn’t want to get the flu shot, we are going to have a very hard time differentiating between COVID-19 or the flu. So we have to test your child for both viruses and then there’s going to create a level of anxiety regarding school, quarantine and care that your child is going to need because we don’t know if it’s the flu.’”

Avoiding Other Illnesses or a Different Pandemic – Maintain Immunizations

“Now you can get the flu after getting the flu vaccine but you’re going to be protected from some of the major complications that we see when you have a natural illness and the duration of the illness is much shorter instead of being two to three weeks with the natural illness, it may be two to three days.

So I explained to the parents the importance of getting all the children’s immunizations on time. And believe it or not, there’s a critical important piece of information I need families to understand: Even though throughout most of COVID-19 pediatricians are open and family doctors are seeing children too, the importance of the well-child visit to be up-to-date and your teenagers, and the shots is critical – because we don’t want to change this pandemic for a measles epidemic or whooping cough so we have vaccines to prevent illnesses so let’s use them, let’s get them.”Avoiding Other Illnesses or a Different Pandemic - Maintain Immunizations Vaccinations for Underserved Populations – Messaging is Key

Vaccinations for Underserved Populations – Messaging is Key

Dr. Jason shared the importance of reaching out to underserved populations is a trustful manner:

“I think there’s a communication point that has to be addressed- particularly for the underprivileged populations – is that getting vaccinations has to come from people who sound and look like them. It cannot come from the systems. And that’s where engaging your community outreach folks is going to be so critical to be able to get those. And it may not be having them coming to the hospital. It may be having the local pharmacy or having folks who are able to engage them there.

Because just as you point out Johanna, there’s so much mistrust and particularly folks are just when you can put the message through a medium that they’re more comfortable with that’s just going to be that’s so critical to address some of the social determinants that inhibit a lot of our understanding.”

Dr. David added:

“And that’s encouraging because it’s going to be needed coming forward. CVS for instance has 1800 testing sites right now around the United States that they’re expanding and they’re in negotiations to become vaccination centers. So just to your point that the neighborhood drug store being actually now a health hub where you can get vaccinated.”

RELATED: Surviving Coronavirus Pandemic & Thriving on the Other Side: Rapid Innovation & Telehealth

The Change to Telehealth

One of the clear changes instigated by the coronavirus pandemic is the rapid adoption of telehealth. Stay-at-home and physical-distancing directives forced providers to rapidly adopt telehealth services or expand existing telehealth capabilities. Long hampered by reimbursement and physician adoption challenges, telehealth use exploded at the end of the 1st quarter of 2022 and has now become table-stakes.

Ferris prompted the panelists to share their take on telehealth and Dr. Johanna began:

Physicians Warming to Telehealth

“So I definitely also want to emphasize the importance of innovation and technology. I would talk to peers six months ago if somebody was telling me that I was going to do a tele-visit. I would have left. I was like: ‘I cannot see a pediatric patient by computer or phone.’

And now is I love it. And definitely it has pushed innovation into healthcare. It was slowly happening but to go from March to April and to see the dramatic jump into utilization of telemedicine is really important because it’s being used as a tool to connect with families; to engage patients; to continue allowing providers and physicians to continue providing the services that they (patients) need, and that is part of value-based care.”

Dr. Johanna urged physicians to answer the question:

Physicians Warming to Telehealth Telehealth - New Opportunities for Providers to Connect with Patients

“How can you think outside of the box in order to reach the population that is yours in order to prove it provides the best outcome for your patients?

And offered a reminder:

“And so the traditional model is one-to-one, in the office, with the physician. And we’re moving away from that model to having health care done in the home environment, remote monitoring, telemedicine, community health workers, other alternative sites of care – in order to complement what we call traditional medicine.”

Telehealth – New Opportunities for Providers to Connect with Patients

Dr. Jason on opportunities for telehealth: elective vs. non-elective procedures

“I think there are two different populations of providers that we need to think about:

1. Elective Procedures – Non-Emergent

Avoiding Other Illnesses or a Different Pandemic - Maintain Immunizations Vaccinations for Underserved Populations – Messaging is Key

“One is the folks who perform more of the elective stuff who are not the frontline workers now. In the sense that David was talking about, the folks who traditionally may have been doing elective surgeries or other sub-specialty care where there is an opportunity to transform the way they’re delivering care. In a way, I think that’s going to be more effective because of the opportunity to accept a lot of the modalities that telehealth has pushed forward.

I’ve been trying to do telehealth 20 years ago. I was trying to push telehealth in. I saw the radiologists, the mental health, and the psychiatrist, they loved it because there’s just so much more opportunity available to them when they’re not one-on-one in a fixed location anymore. And for those folks, I think there’s an opportunity to get back to actually better outcomes; to connect with your patients in a way that you hadn’t before.

It’s kind of like Zoom. We do a lot of training and I love the chat feature because there’s this ability to interact with folks that I hadn’t thought of before. And when you’re open to that I think that, in a lot of ways, it’s going to be very healthy for healthcare providers to be able to connect to the patients.”

RELATED: Should You Go to the Doctor’s Office During Covid-19?

2. Non-Elective Procedures – Emergent

“I think on the other side though is those frontline providers that are still stuck with trying to take care of the folks that are coming through the ER or into their ICU’S; where there’s still not a lot of good information. And the struggle that they’re going to go through of trying to do the best that they can with all the uncertainty and the limitations that we have.

I think for those folks we have to be really mindful that there’s a great burden that our traditional thought about what the role of the provider is that we as a physician, I think, we have to help (our patients) see beyond and get into ‘What’s the best that you can do?’”

Healthcare Supply-Chain – Rethinking COVID-19 Impacts

The ready availability of PPE, medical equipment like ventilators, and certain pharmaceuticals was clearly called into question by the coronavirus pandemic. The lack of a $3.00 mask hampered providers’ ability to serve patients. And $30,000 ventilators are not just easily stocked without serious consideration.

Availability of Personal Protective Equipment – A Matter of Trust

Dr. Johanna shared her personal perspective from previous pandemics:

“I remember H1N1 and it was not like this. There is an element of trust as a provider, and also as a person working in the United States, that I should have not had to worry about where is my PPE coming from. It never crossed my mind in 2009 that I would not have enough PPE to protect myself against H1N1.

 And if you recall, pregnant women were high risk for H1N1. And I was pregnant, caring for pediatric patients, with my second child and I never had to think about it twice. And so now, it’s the anxiety that providers have to know that they’re having the correct equipment in order to provide the care.

 And also knowing so many of our peers are impacted by this disease and have died. It’s something that you need to pause and think about: What are we doing?”

Physician’s New Understanding & Appreciation for Supply Chains

Dr. David on physicians and their supply-chain relationship:

“The other interesting difference is that most physicians in December of last year (2019) probably couldn’t really describe a supply chain and certainly couldn’t talk to you about the strategic value of a supply chain.

Well, after they went through the PPE shortages and pharmacy shortages, they’re now really interested in working with their healthcare stakeholders and hospital stakeholders on how to optimize supply chain activities.

And so there’s a lot of work around nationalizing and onshoring. One of the shortages in the supply chain is the fact that countries nationalize these products, they’re not coming to North America. We’re having to work through that and that’s a big change. So with respect to payment models, we’re already seeing employers – remember there’s going to be some significant economic issues for companies/employers who are not interested in or thinking about value-based care.”

RELATED: With Excess National Supply, Exchanges Will Allow U.S. Hospitals to Continue Meeting Ventilator Demand

Part 3 Coming Soon – More COVID-19 Insight from Physician Executives

In the final post of this three-part series, highlights and details on the following topics from the informal discussion with Dr. Diloreto, Dr. Johanna Vidal-Phelan, and Dr. Jason Woo will be shared:

  • Lessons Learned and Lessons to Be Learned
  • Experiences from Southern Hemisphere – Seasonal Viruses at All-Time Lows
  • Value of Encouraging Use of Masks
  • ‘Long Haulers’ – The Unknown, Long-Term Impact of COVID-19
  • Financial Impact on Providers, Employer Groups, & Payers
  • Employers Forced into New Reimbursement Models
  • Delayed Demand for Non-COVID Services

Live, Interactive Follow-On Chat and Q & A – October 13th

For more detailed information on the topics raised in this series of posts and for a chance to interact with and ask questions of these physician executives, join us on October 13, 2020, at 11:00 am PT/2:00 pm ET for a live, interactive follow-on chat and Q & A opportunity.

The physician panelists will provide additional insight into what’s changed, what’s remained the same, and what may be expected this fall and going into 2021. Questions and requests for additional information shared by registrants prior to and/or during the live chat will be fielded by the panelists.

Reserve your seat and submit your questions and comments today!Be sure to take advantage of this unique opportunity to learn more about what’s presented in this post – and please share it with your associates. And if you are not a subscriber to our newsletter, consider joining 5000+ other healthcare leaders, change-makers, and industry participants and subscribe today!

HCEG HealthCare Executive Group 2021 Top 10Step-1-Selection-Feature-1.jpg

Healthcare Challenges, Issues, & Opportunities – The 2021 HCEG Top 10

By | HCEG Top 10, Resources | No Comments

The HCEG Top 10 list of challenges, issues, and opportunities facing healthcare leaders have been a focus of the HealthCare Executive Group for over a decade. Planned for development by participants at our 2020 Annual Forum, the 2021 HCEG Top 10 list of challenges, issues, and opportunities facing healthcare executives guides our content and programming throughout the coming year. It also serves as the basis for the Industry Pulse research that HCEG and our sponsor partner Change Healthcare have provided over the last decade.

Given the sea change forced by the coronavirus pandemic, the upcoming presidential elections, not hosting our in-person Annual Forum this year, and feedback received about providing more detailed information – a new approach will be used to develop the HCEG Top 10 list for 2021. Four main objectives guide the development of the 2021 HCEG Top 10 list:

Address Impacts from Coronavirus Pandemic & Upcoming Elections

The COVID-19 crisis has clearly altered healthcare priorities and the outcome of the November elections will most certainly do the same. It’s important for the 2021 HCEG Top 10 list to reflect these changed priorities and likely impact from election results.

Deeper Dive into Topics of Interest to Healthcare Executives

In an effort to provide more detailed input and insight into the challenges, issues, and opportunities facing all healthcare stakeholders, candidates for the 2021 HCEG Top 10 list include over 40 ‘sub-topics’ grouped into thirteen ‘themes.” These additional details are expected to provide more value based on the type of healthcare stakeholder: health plan/payer, provider, and risk-bearing provider.

All Virtual Identification, Selection & Ranking Process

Given the absence of our in-person 2020 Annual Forum that was scheduled for this month – and keeping with HCEG’s goal of providing more granular information – the process for identifying, selecting, and ranking core items on the HCEG Top 10 will take place virtually this year.

Open to All Healthcare Industry Participants

Historically, HCEG’s Top 10 process has been limited to HCEG members and attendees of our Annual Forum. Since HCEG is not hosting a physical annual forum this year, and in an effort to collect a wider perspective from a greater number of healthcare industry participants, we’re opening the 2021 HCEG Top 10 process to everyone who cares to participate.

Overview of 2021 HCEG Top 10 Development Process

The following is the high-level process for developing the new HCEG Top 10 list:

  1. Identify “Initial List of 2021 HCEG Top 10 Themes & Sub-Topics” (COMPLETED)
  2. Solicit Feedback on Initial List from Industry at Large (9/16/20 through 11/4/20)
  3. Collect rankings of the Top 10 Sub-Topics identified in Step #2 (11/15/20 through 11/30/20)
  4. Announce 2021 HCEG Top 10 List (12/14/20)

Help Select Candidates for the 2021 HCEG Top 10

The following are the major thematic categories proposed for the 2021 HCEG Top 10. A list of the sub-topics associated with each theme can be found here.
Take Step 1 of the 2-Step 2021 HCEG Top 10 development process today.  This survey should take less than 5 minutes to complete.  If you are unable to complete the entire survey, we urge you to complete as many of the sections as possible that you consider important.

Thank you in advance for sharing your insight. Please contact us at [email protected] if you have any questions or comments. And join our newsletter to receive information, ideas, and insight for healthcare executives and change-makers: bit.ly/hcegnewsltr

Physician Perspectives on COVID-19 Impact to Fall Season

Webinar: Physician Perspectives on COVID-19 Impact to Fall Season

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In early September, the HealthCare Executive Group hosted an informal discussion with three physician executives. Long-time HCEG board member Dr. David Diloreto, MD, a board-certified ophthalmologist, ophthalmic plastic surgeon, currently a principal at Vizient/Sg2 and prior senior vice-president at GE Healthcare Camden was joined by Dr. Johanna Vidal-Phelan, MD Senior Medical Director in Pediatrics at the University of Pittsburgh Medical Center Health Plan and a practicing pediatrician at Hamilton Health Center, an FQHC in Harrisburg, PA.and Dr. Jason Woo, MD, a practicing board-certified obstetrician/gynecologist and a veteran with 31 years in the Commissioned Corps of the U.S. Public Health Service and consultant at the Arbinger Institute.

The discussion was centered on COVID-19’s impact over the past months, what’s changed, what’s remained the same, and what they’ve each observed and learned over the past months – particularly from a clinical and public health role. The following topics were discussed:

Impact Factors Affecting Utilization of Services The Change to Telehealth: New Opportunities for Providers to Connect with Patients
Balancing Treatment to Avoid Ongoing Destruction of Demand for Non-COVID Services Rethinking the Healthcare Supply-Chain – PPE as a Matter of Trust
Returning to School & Addressing Disadvantaged Populations Lessons Learned and Lessons to Be Learned
A Pediatric Physician on Sending Kids – Including Her Own – Back to School Experiences from Southern Hemisphere – Seasonal Viruses at All-Time Lows
Impacts on Minorities & Underserved Populations Value of Encouraging Use of Masks
Uncertainty in Testing and Understanding Prevalence ‘Long Haulers’ – The Unknown, Long-Term Impact of COVID-19
How Long Will We Be Dealing with COVID-19? Financial Impact on Providers, Employer Groups, & Payers
COVID-10 Vaccines & Importance of Fall Flu Shots Employers Forced into New Reimbursement Models
Avoiding Other Illnesses or a Different Pandemic – Maintain Immunizations Delayed Demand for Non-COVID Services
Vaccinations for Underserved Populations – Messaging is Key

The information, insight, ideas, and predictions from this informal discussion are presented in a 3-part blog series and you can read Part 1, Part 2, and Part 3.

Live, Interactive Chat and Q & A – Physician Perspectives on COVID-19

Join this special October event, interact with and ask questions of these physicians Tuesday, October 13, 2020, at 11:00 am PT/2:00 pm ET. Questions and requests for additional information shared by registrants prior to and/or during the live chat will be fielded by the panelists.

Reserve your seat and submit your questions and comments today!

COVID-19 Insight. COVID-19 Impact to Healthcare: Physician Perspectives on the Fall Season. Supply chain challenges. Telehealth virtual health services. Dealing with financial uncertainties. Coronavirus Pandemic. Back to School.

COVID-19 Insight: Physician Perspectives on the Fall Season (Part 1)

By | HCEG Content, Resources | 2 Comments

The coronavirus pandemic has changed the world dramatically. Since late February, healthcare organizations have been largely in crisis mode – adapting to new testing and treatment demands and strategies – all while struggling to stay afloat emotionally, physically, and financially during these difficult times.

  • They’re dealing with supply chain challenges.
  • They’re adopting telehealth or accelerating their existing use of virtual health services.
  • They’re dealing with financial uncertainties due to either their focus on COVID-19 or due to the destruction of demand for non-COVID related services.
  • They’re navigating the harsh reality of a reimbursement system based on volume.

And there are many other changes caused by the pandemic and the response to the pandemic that are not yet known or fully understood.

And now, our school systems are struggling to safely re-open and bring some semblance of normality back to families and children. And as autumn rapidly approaches, addressing concerns about the potential impact from kids returning to school and the fall flu season are topics of discussion among many people.So what’s changed and what’s remained the same? What have healthcare leaders – particularly those serving in clinical and public health roles – observed and learned over the past months? What challenges, issues, and opportunities should they be focusing on? Is there a yin-yang opportunity available?

COVID-19 Insight, Information, & Ideas from Physician Leaders

To help answer these questions, the HealthCare Executive Group hosted an informal discussion with three physician executives. This post, the first in a series of three, shares some highlights and some details from that discussion.

Look for the remaining posts over the coming weeks and be sure to subscribe to our newsletter for more information on potential value to healthcare leaders and change-makers.

Listen to the entire recording here

Physician Leader Panelists

Long-time HCEG board member Dr. David Diloreto, MD, a board-certified ophthalmologist, ophthalmic plastic surgeon, currently a principal at Vizient/Sg2 and prior senior vice-president at GE Healthcare Camden was joined by Dr. Johanna Vidal-Phelan, MD and Dr. Jason Woo, MD.

COVID-19 Impact to Healthcare: Physician Perspectives on the Fall Season Panelist Biographies - Dr. David Diloreto COVID-19 Impact to Healthcare: Physician Perspectives on the Fall Season Panelist Biographies - Dr. Johanna Vidal-Phelan COVID-19 Impact to Healthcare: Physician Perspectives on the Fall Season Panelist Biographies - Dr. Jason Woo
Dr. David Diloreto, MD Dr. Johanna Vidal-Phelan Dr. Jason Woo, MD

Dr. Johanna Vidal-Phelan, MD (Dr. Johanna) is Senior Medical Director in Pediatrics at the University of Pittsburgh Medical Center Health Plan and a practicing pediatrician at Hamilton Health Center, an FQHC in Harrisburg, PA.

Dr. Jason Woo, MD (Dr. Jason) is a practicing board-certified obstetrician/gynecologist and a veteran with 31 years in the Commissioned Corps of the U.S. Public Health Service. Dr. Woo is a consultant at the Arbinger Institute.

In addition, HCEG’s Executive Director Ferris Taylor helped to facilitate the discussion and provide HCEG perspectives. For more on the background and expertise of these participant leaders, see their bios here.

Live, Interactive Follow-On Chat and Q & A – October 13th

COVID-19 HealthCare Executive Group hosted an informal discussion with three physician executives.For more detailed information on the topics raised in this series of posts and for a chance to interact with and ask questions of these physicians, join us on October 13, 2020, at 11:00 am PT/2:00 pm ET for a live, interactive follow-on chat and Q & A opportunity.

The physician panelists will provide additional insight on what’s changed and what’s remained the same under COVID-19 with more on what expect this fall and going into 2021.

Questions and requests for additional information shared by registrants prior to and/or during the live chat will be fielded by the panelists. Reserve your seat and submit your questions and comments today!Be sure to take advantage of this unique opportunity to learn more about what’s presented in this post – and please share it with your associates.

Discussion Kickoff

Ferris Taylor welcomed everyone, offered a short summary of the goals of the informal discussion and passed the microphone (virtually of course) to Dr. Diloreto to kick off the discussion by sharing some information and insight collected over the last six months.

Physician Executives on COVID-19 Over the Last Six Months

“Supply chain issues this spring and the PPE and pharmaceutical shortages have presented new challenges, issues, and opportunities to analytics companies; re-doing their algorithms to account for co-covered impact factors.

Results of market demand forecasting and essentially what we’re seeing is a lot of what we have been virtual health. we’ve been we’ve probably compressed the trend for adoption of virtual health by five to seven years and now people are figuring out well that was bootstrapping and video conferencing with families but how do we really get the provider workflows adjusted so that this is meaningful and a productive way to deliver care.”Physician Executives on COVID-19 Over the Last Six Months

Impact Factors Affecting Utilization of Services

“The other thing we’re looking at that’s interesting is how the impact factors are affecting utilization of services. Early on we saw folks just avoiding the emergency room even staying home with symptoms of stroke and myocardial infarction. The high acuity services have returned but low acuity services have not, and we don’t believe they ever will.

These are things that basically probably shouldn’t have been in the emergency room to start with and folks are finding ways to deal with it. High acuity conditions like TAVR (Transcutaneous Aortic Valve Replacement) procedures and neurosurgical procedures are actually coming back really strong. People almost at full comparing the first six months of 2019 the first six months of 2020 basically the same utilization rates.

What’s interesting are more elective procedures including things like PE tubes in children – which have only come back to about 40 %. And so one of the issues there is could be a combination of factors. In the social distancing that was happening in the spring maybe there was less UTI and eye infections. On the other hand, families that we know are avoiding preventive services. There may be children with chronic ear infections not getting detected now. There are things that may play out long term that we have to figure out. So there’s a variable return of on the provider side of certain services.”

Dr. David went on to share more about:

Balancing Treatment to Avoid Ongoing Destruction of Demand for Non-COVID Services

COVID-19 Non-COVID Elective Services

  1. They have to balance the treatment of COVID positive patients and non-COVID positive patients in the pandemic. And we watch those surges in places like Tampa and Los Angeles and Houston last month. And actually the provider community is getting a lot better at being able to balance that care. We know more about early intervention with certain treatments. There’s less folks going on onto ventilators and obviously we’re protecting the most vulnerable people in the elderly and institutions much better. 
  1. On the other hand, the impacts financially both from demand destruction as well as increased costs are huge. We’re seeing provider groups, hospitals and health systems really having to deal now with not only the near-term financial recovery but also some very significant economic issues. We’re looking at unemployment rates in Florida right now and in Orlando where there’s high rates of people employed in tourism and entry-level service jobs unemployment rate of about 20%.

Returning to School & Addressing Disadvantaged Populations

  1. Should I send my children to school? What should I look for? Am I at risk? How will they (children) interact with aunts and uncles and grandparents? Is it really safe? And if they don’t go to school, what does that mean? 
  1. The impact in disadvantaged communities has been huge and it plays out in interesting ways not just in urban centers but was really interesting as we watched the surges in Los Angeles, Tampa and Houston as they came down the nearby rural areas particularly where you had either migrant workers and low-income workers in fields they were getting infected at very high rates. That’s probably sort of the fits and starts with this that we’re going to have throughout this pandemic until there’s widespread use of vaccines, herd immunity and more effective therapies

A Pediatrician on Sending Kids – Including Her Own – Back to School

HCEG Three Physicians on COVID-19 A Pediatrician on Sending Kids – Including Her Own - Back to School

Dr. Johanna was asked: What are you advising your patients on when they ask you: “Is it safe to send someone to school? As both a Practicing pediatrician and a parent of two school aged children, Johanna shared:

“So that’s a very important question and each family will have a different solution. I think that the first thing I have to tell parents and including myself as a parent is to empower the parent to make the decision. And there’s no wrong or right decision. You need to do what’s right for your family. And so, in partnership with the school district where your children are, I’m going to think about different things that had happened in the last 10 years for families and children. This has been one of those aspects that had created a lot of anxiety for families including myself. And I think a topic of importance to discuss is in regard to the home environment. 

Most of the kids in the state of Pennsylvania are not having the opportunity to return to school full-time – so not five days. They’re doing a hybrid model or fully online. What is the impact for a working family that has to figure out how to come up with new solutions in regard to the care of the children during the days that they are not in school?”

Impacts to Minorities & Underserved Populations

“And the financial hardship that that may represent to a family. I’ve seen families make very challenging decisions where one of the parents is no longer working. So that parent can help with the children in the home environment for schooling. And other families are sending their children though they don’t want to, or they don’t feel comfortable because they have to go to work. I’ve seen a really dramatic impact in Latinos and minorities. As you know, Latino families/minorities families are mainly in the service industry – many of us. So what happens is that the level of exposure to COVID-19 is higher – disproportionately impacting African Americans and Latinos. 

So you think about families and the impact in children and what that means to them is significant. It is a very challenging question. Parents ask me all the time in the pediatric practice and I respond with the answer: What is it that is important to you as a family? What is it that you can provide or not for your children education? And then we have a frank discussion about what the family will need to do.”HCEG Uncertainty in COVID-19 Testing and Understanding Prevalence

Uncertainty in Testing & Understanding Prevalence

Dr. Jason followed on with:

“I think, coming from the public health perspective particularly the FDA background, there’s just so much uncertainty in the testing and understanding incidents prevalence and what the outcome of an infection is. It’s so critical to be non-judgmental of what – as you pointed out Johanna – each family has to figure out what’s best for them. 

As we’re providing services, part of the challenge is to be aware of the individuality that has to be accounted for each of the patients or each of the patients coming or families coming into the healthcare system and trying to figure out what’s right for them.”

A Perfect Petri “Diamond Princess” Dish – Wasted

“I think the one thing I kicked myself is, at the beginning of all this, I was so certain that we would have such good data from the date of the Diamond Princess. There were 3000 patients, they’ve been isolated, they’re dropping CDC resources in there, they’re doing sampling and we’re going to have so much information. And then after two weeks and nothing’s coming out. I had completely missed out. 

We talk about the public health system being underfunded but I never expected us to be so poorly informed in terms of the data of the natural course of the infection, of infectivity, of how quickly it spreads and how it spreads. And so now with the plethora of different testing and the different way things are being approved by the FDA, I think it’s challenging because it’s just not the kind of data or standards that we would have had when we did Ebola, when we did Zika. 

I wouldn’t say it’s for lack of knowing how to deal (with it), it’s just the challenge of not having a sort of a standard upfront approach prepared to go up front. And I don’t say politics. I don’t want to point fingers at all in this.”

RELATED: Leadership, Trust & Skills in Overcoming Obstacles to Radical Innovation in Healthcare

How Long Will We Be Dealing with COVID-19?

Ferris mentioned reading about a poll asking physicians when physicians are expecting to be “on top of or ahead of COVID-19.” Ferris related that 50% of physician respondents are expecting that we won’t be on top or ahead of COVID until June of 2021.How Long Will We Be Dealing with COVID-19?

Dr. David shared some other insight from his organization:

“Our projections are that we’ll be dealing with a pandemic situation probably into the fourth quarter of next year (2021) simply because the production and distribution of effective vaccines – and of course the early trials are encouraging – but it’s still a monumental undertaking. And also, we still don’t know the issues about long-term effectiveness (of any vaccine). There’s still a lot of volatility around that.” 

“It seems like 2020 has been a decade. We’re finally in August and so in addition to dealing with an ongoing pandemic, we’ll have seasonal viruses and seasonal respiratory infections starting to come into play. Tell us a little bit about how you think it’ll affect frontline practices particularly with respect to testing strategies and recommendations for families.”

Dr. Jason countered:

“The question is: what do states do at this point in terms of making requirements that some of the school-age kids must meet to even participate? 

I think New York already came out with the mandatory testing; I think California also as well. There’s certainly been a lot of confusion. There are factors that – as you point out – variables that if kids aren’t in school how does that affect exposure rates that we’re not going to project the uncertainty as a provider. I think that you’re presented with where folks are coming in is certainly so dependent upon where our testing capabilities are. And how much better knowledge we have. And how quickly folks can respond to that. And that’s why it’s very difficult. 

It gets back to the uncertainty of how quickly these conditions continue to evolve and to what extent we’re able to get better information. There seems to be a lot of people working very hard at it but there’s just so much variation in the testing and so I think it’s going to be particularly hard for providers to make that (decision) but there’s just still a lot of uncertainty about what those actual prevalence rates are going to be with the different conditions. 

I’d also ask, if kids aren’t in school, how does that affect the general trend of seasonal viruses?”COVID-19 Insight. COVID-19 Impact to Healthcare: Physician Perspectives on the Fall Season. Supply chain challenges. Telehealth virtual health services. Dealing with financial uncertainties. Coronavirus Pandemic. Back to School.

Part 2 Coming Soon – More COVID-19 Insight from Physician Executives

In the next post of this three-part series, highlights and details on the following topics from the informal discussion with Dr. Diloreto, Dr. Johanna Vidal-Phelan, and Dr. Jason Woo will be shared:

  • COVID-10 Vaccines & Importance of Fall Flu Shots
  • Avoiding Other Illnesses or a Different Pandemic – Maintain Immunizations
  • Vaccinations for Underserved Populations – Messaging is Key
  • The Change to Telehealth: New Opportunities for Providers to Connect with Patients
  • Rethinking the Healthcare Supply-Chain – PPE as a Matter of Trust

Live, Interactive Follow-On Chat and Q & A – October 13th

For more detailed information on the topics raised in this series of posts and for a chance to interact with and ask questions of these physician executives, join us on October 13, 2020, at 11:00 am PT/2:00 pm ET for a live, interactive follow-on chat and Q & A opportunity.

The physician panelists will provide additional insight on what’s changed, what’s remained the same, and what may be expected this fall and going into 2021. Questions and requests for additional information shared by registrants prior to and/or during the live chat will be fielded by the panelists.

Reserve your seat and submit your questions and comments today!Be sure to take advantage of this unique opportunity to learn more about what’s presented in this post – and please share it with your associates. And if you are not a subscriber to our newsletter, consider joining 5000+ other healthcare leaders, change-makers, and industry participants and subscribe today!